Running Head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgment

Kelsey Baker

Youngstown State University

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Abstract

This paper explores the meaning of clinical nursing judgement, identifies the importance of

clinical nursing judgement, and includes a personal experience of a time that I have used clinical

nursing judgement. Three different research articles are discussed in the paper. The first article

mentioned is written by Paneuf (2008) and it discusses the definition of clinical nursing

judgement. Another article included in the paper written by Graan, Williams, and Koen (2016)

discusses the publics understanding of clinical nursing judgement versus reality, and lack of

clinical nursing judgement in new graduates. The last article discussed is written by Kyung Oh

(2016), which will explain strategies to improve nursing students clinical nursing judgment.
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What is clinical nursing judgement? Clinical nursing judgement can be defined in

several different ways. There is no right or wrong way to define clinical nursing judgement,

because it is just that, a judgement. I however agree with the following definition of clinical

nursing judgement. Le Grand Robert, a French dictionary, defines judgement as having an idea,

a clear opinion following a period of reflexion whereas the term clinical indicates that it is

related to the patient. A difficult task for nurses is making a clinical judgement. It requires both

intellectual and professional maturity. In particular, it requires the ability to pay attention, to

reason and to summarize in order to achieve logical deduction. Clinical judgement is complex

because the nurse is required to have prior training in order to develop further understanding of

the subject. It depends on her ability to observe, to identify relevant information, to identify the

relationships among given elements and to reason. Clinical judgement in itself encompasses a

cycle of sensory activities which begins with perceptions and which is followed by cognitive

functions associated with the intellectual processing of information through the mental

operations of reasoning and judgement (Phaneuf, 2008). As previously mentioned, clinical

judgement is a very complex and may vary from nurse to nurse. For example, a nurse that has

twenty-five years of bedside nursing experience will most likely have better clinical judgement

than the new graduate nurse simply because of experience. On the other hand, some may argue

that a new graduate has better clinical judgement because new graduates are typically nervous to

mess up, resulting in more thorough assessments and documentation than an older, experienced

nurse would provide. Overall, clinical judgment focuses on the patients. Having good clinical

judgement means that the nurse is advocating for their patients, improving quality of life for their

patients, and alleviating stress and anxiety that their patients may be experiencing.
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Clinical nursing judgment is important for the doctors, nurses, patients, and families. It

affects everyone involved with the patient, which is why it is so important. Studies have shown

that clinical nursing judgement leads to, The identification and logical interpretation of

symptoms; the planning of care to alleviate or prevent complications or relapses; the nurse is

doing what the patient would do for himself if he had the required strength or knowledge;

helping the patient satisfy his physical, psychological and spiritual needs at the same time; and

assisting the patient in passing away with dignity, if necessary (Phaneuf, 2008). It is important to

understand that clinical judgement includes assessment, diagnosis, implementation, and

evaluation. Graan, Williams, and Koen (2016) have found that many of the public view nursing

as a profession that simply keeps sick people safe, comfortable and clean and helps carry out the

tasks requested by the doctors. While those assumptions are true, there is more to nursing than

comfort provided at the bedside. The difference between a skilled professional nurse, and a non-

professional caregiver is the ability to assess, diagnose, implement, and evaluate the patient. In

todays environment, patients are more critical and more complex. Clinical nursing judgement is

more important than it ever has been. The patients and institutions need their nurses to be

competent and capable of critical thinking skills. According to research by Graan et als. (2016),

newly qualified nurses are not meeting the expectations for entry level clinical judgement.

Clinical judgement no longer includes following the process, analyzing the data and performing

prescribed techniques. If a nurse is going through the motions, that cannot guarantee good

clinical judgement that will solve the patient's problems. It is important for clinical judgement to

include the nurse determining appropriate nursing interventions when planning the patients care

in order to receive good outcomes. Good clinical nursing judgement starts developing in the

classrooms and clinical. Unfortunately, research is determining that one of the reasons that new
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nurses are not meeting the expectations for entry level positions falls back on insufficient use of

time in clinical teaching. Research provided by Kyung Oh (2016), concluded that structuralized

debriefing processes that utilize the clinical judgment rubric improved nursing students clinical

judgment and communication scores and impacted their skill performance. The use of structured

clinical judgment rubric debriefing can be used as an effective teaching and learning strategy to

achieve learning goals related to clinical judgment, communication, and skill performance which

is very important for new graduate nurses.

As I am approaching graduation, reality is starting to hit me. I will soon be a registered

nurse, and have quickly realized that I will be using clinical nursing judgement every day in this

career. Already, as a student nurse, I have used clinical nursing judgement which has helped me

prepare learn and develop critical thinking skills to prepare me to be the best nurse that I can

possibly be. A specific situation that sticks out to me when I used clinical nursing judgement was

a couple of weeks ago while I was precepting. My precepting nurse and I were floated down to

the Emergency Deparmtent to triage patients. My nurse was allowing me to do the initial

assessments on the patients and then she would verify after I was finished. A sixteen-year-old

boy can in from his work because he felt extremely weak, he had a headache and he had no

energy. He had a low-grade fever, the chills, and was very achy. His blood pressure, pulse, and

respiratory rate was all within normal limits. After his assessment, I noted that his throat was red,

with swollen tonsils. I immediately thought that we should do a rapid strep test on the patient.

My precepting nurse agreed with my assessment and decision to do the strep test. I swabbed the

patients throat, and within two minutes the strep test came back positive. This is a perfect

example where I used clinical nursing judgment during my assessment, implementation and

treatment of the patient.

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References

Graan, A. C., Williams, M. & Koen, M. P. (2016). Professional nurses' understanding of clinical

judgement: A contextual inquiry. Health SA Gesondheid, Volume 21, Pages 280293.

Retrieved from http://www.sciencedirect.com/science/article/pii/S1025984816300047

Kyung oh, H. (2016). Effects on Nursing Students Clinical Judgment, Communication, and

Skill Performance Following Debriefing using a Clinical Judgment Rubric. International

Journal of Bio-Science and Bio-Technology, Vol.8, No.1. Retrieved from

http://www.sersc.org/journals/IJBSBT/vol8_no1/27.pdf

Paneuf, M. (2008). Clinical Judgement An Essential Tool in the Nursing Profession. Retrieved

from http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement

%E2%80%93An_Essential_Tool_in_the_Nursing_Profession.pdf